Emotional Engagement as a Push Factor in Medical Student Migration Intentions

Introduction

Migration intentions among medical students signal potential loss of future health workforce capacity and are often interpreted through push–pull frameworks. While structural drivers are well known, individual-level factors within the educational environment remain underexplored. Emotional engagement, reflecting a sense of belonging and identification with the learning context, may act as a push factor influencing migration intentions.

Methods

In 2025, we conducted a cross-sectional study among 512 third-year medical students attending the Faculty of Medicine, University of Belgrade. Sociodemographic data were collected. Student engagement was assessed using the University Student Engagement Inventory (USEI), conceptualized as a higher-order construct with behavioral, emotional, and cognitive dimensions, measured by 15 items on a five-point Likert scale.

Results

Participants were mostly female (72.7%), with a mean age of 21.7±1.29 years. A substantial proportion reported intentions to work abroad (43.2% moderate, 28.9% high, and 8.0% actively planning). Engagement scores indicated high behavioral (3.64±0.7) and cognitive (3.82±0.82), but moderate emotional engagement (3.09±0.72). Lower emotional engagement was associated with higher odds of migration intentions (p = 0.016, OR = 1.659; 95% CI 1.099–2.504), whereas behavioral and cognitive engagement had no significant association. Students without a physician parent had a higher likelihood of migration intentions (p = 0.041, OR = 0.606; 95% CI, 0.375–0.979).

Conclusions

In our study, lower emotional engagement functions as an individual-level push factor shaping migration intentions. A reduced sense of belonging and professional identification may weaken early attachment to the local health system. Interventions that strengthen emotional engagement during training could represent an upstream strategy to support health workforce retention.

Key messages

• Lower emotional engagement among medical students is associated with higher migration intentions, indicating a potential early push factor for future health workforce loss.

• Students without a physician parent are more likely to report migration intentions, suggesting that the absence of professional role models may influence workforce retention.